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What happens if a therapist decides someone might be a danger to themselves?


Julie in CA
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Depends on the what kind of danger. If someone is prone to suicidal thoughts, the doctor would try to make sure the person is staying with a relative that is able to keep an eye and remind the person to take meds. Sometimes inpatient is suggested. I have a few friends who have been through that :(

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I was thinking about that this morning, when I read this thread:

 

http://forums.welltrainedmind.com/topic/458170-in-thinking-about-how-to-raise-my-sons-this-affected-me-profoundly-warning-suicide/

 

This young man didn't get the help he needed because he was functioning at such a high level. There were warning signs, but no one took them seriously. Thank God that you seem to be more sensitive to potential danger. Hugs to you.

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In my experience they either release the person to a relative who agrees to constantly remain with the person until they can be assessed again or the person is admitted to an inpatient facility. Meds are prescribed but those take a while to help. I hope you are ok.

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Some people are mandatory reporters. Meaning that if they think a person is an immediate danger to themselves or to others, or has committed a crime, they are legally obligated to take certain steps. Mandatory reporters can have some one checked into a psychiatric hospital for a temporary period based upon their recommendation. The exact laws vary by state to state.

 

Psychiatrists, clergy, social welfare workers, teachers, and some other professional classes are mandatory reporters. Clergy are exempted if the information is shared under the seal of confession. But, as I understand it, part of the problem with the sex abuse scandal in the RC church is that the people who knew what was going on and hid it were legally obligated to report it.

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First of all, the therapist's first level of assessment is to determine whether the person actually is a danger to themselves and there is more latitude in that than many lay people might think. For instance, upon hearing that a patient had suicidal thoughts, a clinician might ask if those thoughts are more of a metaphor for how bad the client feels, or if they are more of a plan. For many people, they are a metaphor and don't represent an actual risk (though there are better metaphors to use!) If the thoughts are more like a plan, the therapist would determine how imminent the plan is. If the plan is to take pills the patient already has at home, that raises the risk. If the thoughts are to take a certain kind of pills, but the patient doesn't have any of those, it is less imminent and less of a risk. Risk is also assessed by how deadly the means is (gun that person can lay hands on is more deadly than some kinds of pills, for instance.) If there is some risk as in a plan, then the therapist will decide what level of intrusiveness is necessary. Some people are safe with a contract to contact the therapist first before they would attempt suicide; others may contract to give the pills to a friend; others require 24/7 supervision from relatives; still others need to be involuntarily committed. Therapists try to use the least intrusive method that still gives safety to their client.

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Then the therapist recommends a treatment plan that gets the person the help they need. It's not a bad thing, but it can he a scary thing. It is a necessary thing. It isn't easy, but getting help for this most serious of mental help issues is a brave thing to do. The right thing to do. Help is there, and I hope that anyone in need of it will take it.

 

 

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The therapist asks questions to determine if the person has serious thoughts of suicide, a plan which is realistic, and an intent to carry it out. With all three of these, the person is considered to be in imminent danger of harming themselves, and a therapist will assist the person in going to a hospital ER or a psychiatric hospital for evaluation. In Texas, a therapist does not have the authority to "commit" a person. This must be done either voluntarily by the patient or through a mental health warrant, which is a legal proceeding. I hope things are okay for you and your family.

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((((hugs))))

 

Stay strong, Julie. I'm rooting for you.

 

Suicide is a bomb in the pond of the family and community of the person who leaves. Having lost a family member, and having also lived through my best friend losing her brother . . . I know all too well the devastation suicide leaves behind. Those deaths were 16 & 10 years ago, but their families still are ravaged by the losses, and no one escaped undamaged by the brutal devastation they left behind. It may seem like a simple solution to the devastating difficulties of life, but it destroys everything good that someone has touched. The siblings, parents, uncles, children . . . The innocent along with the not-so-innocent, they are all devastated.

 

No matter how frail or weak we are, we have a moral obligation to get the help we need so we can avoid destroying the beauty in the lives of others.

 

I have had times in my life when I didn't feel strong enough to go on, and when I truly would have preferred to be dead than continue the struggles, but even though I wasn't wise enough to understand that those times DO pass, I was able to hold on to the people I loved and just not consider the option of dying.

 

During a dark time, I once described my young children as the "tethers" who held me to the world. I could never choose to leave the world, as they hold me here more surely than a steel cable. The young men I knew who suicided didn't even have spouses or children yet, but their deaths nonetheless left devastation in their families of origin. I can't fathom the depth of destruction the suicide of a parent creates in the children left behind -- those children who will NEVER stop questioning why they weren't good enough for their parent to want to even live to be with them. That will curse their every moment, those that should rightfully be beautiful and joyous will be tainted with unending pain of loss and rejection.

 

Dark days do pass. I shudder to think of the days I would have preferred not to have woken from sleep, as my life now is so precious to me. The two people who I have personally known who have committed suicide each had families (and friends) that loved them passionately, and each would have surely had wonderful lives if they had't succumbed to responding to transient pain with an irrevocable decision.

 

((hugs)) and prayers. Please call someone who loves you. Or call a crisis line. Or go to the ER. If YOU aren't enough to hold you to the earth, then let someone or something else tether you.

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I'm ok. Mostly.

 

The therapist has let me know that he considers my...husband (?) guy who lives in the house (?) (yes, he's still here)...to be a candidate for suicide, and that I should be watchful. The man I've been married to for 25 years is well and truly broken inside. He holds it together in public (mostly), though it's clear to everyone that it's a false appearance of everything being ok.

 

I have been very careful not to mention just how often I think about how much nicer it would be to permanently end the pain, because, as another poster mentioned, I have such strong obligations to other people that I could never take that way out. I'm...distressed about how often I consider (and reject, btw) options though. I don't want to mention it to the therapist, because I really don't want to end up in the position of having him feel he needs to take action. Wanting to be dead, thinking about how it could happen, and deciding to do something about it are very different things, I think. Probably.

 

I have chosen a nearly impossible course, one in which I protect everyone but myself. I'd like to think I am strong enough to carry out my plan, but very often I think that I Just. Can't. Do. It.

 

I have great reasons. Stay put for 2-4 years, expecting to get out when youngest dd isn't so reliant upon us. During that time, I'll be able to take care of her (and older dd), take care of my completely broken (but also hard-hearted, sadly) husband, get him and the family through the bankruptcy and loss of the farm that is still looming, and have that time to better prepare myself to be self-supporting physically, financially, and hopefully mentally. After all, even if we separated now, my dc would still need to spend time with this person who looks like their dad, but just...isn't. Without me here, they would be on their own with him. At least if I'm here, I can help the kids through that.

 

If, during the time I stay, I'm able to help my broken husband heal, all the better. I'm not holding my breath though, because I truly do not see that happening. He's clearly emotionally ill at this point, and is having some...not sure what the technical term would be--cognitive impairment? He's having difficulty with regular things like decoding words, memory issues, etc. He truly doesn't remember his inappropriate actions with that young woman, and it's not just him trying to pull one over on me. He's clearly drawing a blank if anyone mentions it at all.

 

I would like to help him inasmuch as I can (especially if it will benefit my dc). I hold it together when I'm in public, and I hold it together (mostly) when I see the therapist, because when I'm there I can feel like someone cares if I'm sad.

 

The man I married could never *ever* have watched me in this much pain and behaved coldly. He's not just making poor choices, he's just truly *not able* to do any better at this point. That phrase, "The lights are on but no one's home"? Yeah. That's him. It's so sad. He's absolutely one of the best people I've ever met. Heart of gold. At least, that's how he *was*. Now he's just a shell, albeit one that still has my heart and is able to hurt me so deeply that I'm not sure I can make it through this.

 

I have some REALLY great reasons to try to stick this out for a while. They're all noble reasons. They're all "take the high road" reasons. I don't think I will ever be sorry for having tried to do the best thing for my kids, and for the man who 25 years ago I promised to love in sickness and in health. I don't have to stay forever, I just have to make it until I've taken care of those really important things. I realize it looks like I am making some colossal mistakes, and that I'm making a choice which may or may not turn out to be foolish in the end. Y'all will just have to trust that I've weighed the options and I don't think I'll be sorry for trying this, but I know myself, and I *will* be sorry if I don't try to make the best of what is right now.

 

So, am I ok? Maybe. I don't know. Today is over and I'm still breathing in and out. That's a win, at least on my scoreboard.

Tomorrow, who knows?

If you're a pray-er, thank you for doing so. I'm not feeling as close to my faith as I need to be, so I appreciate those who are doing the praying *for me*, since I'm failing a little bit in that regard.

 

Thanks also for the hugs. There are very, very few of those in real life these days, and sometimes I crave it like I crave my next breath.

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Oh, Julie. I have no words for what you're going through, but I hope you know how much we all care about you, and want you to be happy and healthy. I know your concern is for your kids (as mothers, is there ever a time that's not true?), but please remember that you need to take care of yourself too. Take the love and strength we are sending you, and build yourself up with it. :grouphug:

 

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Praying, Julie.

 

When I am at my best personally, I am able to see that my husband is *unable* to make mature, good choices. When I am not at the top of my game, his behavior absolutely seems intentional. He, too, had a ........... interaction? that was entirely inappropriate.

 

I've been playing the stay intact game since last summer because of a pro-con list not unlike yours. I've lived a soul killing marriage before; I never, ever imagined this would be another one. The man sitting in the den is not the man I married (unlike my first husband, who was who he was from beginning to end, I just didn't see it.)

 

I'm not trying to hijack, but to offer a small "you are not alone" in what might seem like very unique and odd circumstances.

 

BTW, my husband did a short term stay at an emergency psychiatric center a while back for suicidal ideations.

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oh julie. an inpatient program to evaluate him, even for a short time, might lead to some help that he really, really needs.

 

does the person he sees understand the state of your relationship?

 

that is a huge piece of the puzzle that they need to have, if they don't.

 

hugs,

ann

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does the person he sees understand the state of your relationship?

 

He doesn't see anyone. This is an MFT that we saw briefly together at the beginning of all of this. I still go. The therapist does understand the situation. He seems worried that dh's shell might crack one day, and has told me to be watchful.

 

I have not told the therapist how despondent I frequently am at this point, and I don't want to if it means he might feel like I need intervention in a more assertive way. Still, I'm a bit worried and a bit embarrassed about how often it pops into my mind that it would be lovely to leave this world behind.

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Oh, Julie, you have such strength and grace.

 

I believe that any decent therapist can well understand the difference between thinking about it being easier to be dead and a specific immediate intent to harm yourself.

 

I think you are strong and are thinking clearly and generously. Only you can know the best course for your life and only you has the responsibility for your family. There is no easy answer for you, and any choice you make has pain involved. No one has the right to judge you.

 

I wonder if your husband could be suffering from a medical condition like Alzheimer's? Or a brain tumor? So many symptoms you describe sound like Alzheimer's. I know that depression and other mental illnesses can mimic those symptoms, but medical conditions can also produce symptoms that mimic mental illness.

 

I will hold you in my prayers and thoughts, for comfort and peace. I am so sorry you are going through this terrible time.

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I wonder if your husband could be suffering from a medical condition like Alzheimer's? Or a brain tumor? So many symptoms you describe sound like Alzheimer's. I know that depression and other mental illnesses can mimic those symptoms, but medical conditions can also produce symptoms that mimic mental illness.

 

:iagree: :iagree: :iagree:

 

Is there any way you can convince him to go for a neurological evaluation? I have heard so many stories of people whose personality change and erratic behavior turned out to have a neurological cause like dementia, stroke, a tumor, etc.

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Gently...

 

Please don't take this as me thinking you haven't thought it through - I'm sure you have. The reality of 2-4 years is much longer than the thought of that amount of time. If you are determined to take this route, please make sure you have outside support during that time.

 

:grouphug: I'm so sorry about all you've gone through and continue to go through. :grouphug:

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Gently...

 

Please don't take this as me thinking you haven't thought it through - I'm sure you have. The reality of 2-4 years is much longer than the thought of that amount of time.

 

 

I know. :sad:

I've decided what I think would ultimately be the *best* choice, but I concede that it is anywhere from hard to nearly impossible.

I'm trying it anyway.

Still, I've been very clear with myself that I'm gonna let myself off the hook without guilt if I just can't get through it, or if the thoughts that life just isn't worth it become more pervasive. Judging when I've reached a level that is dangerous is the hard part, and my answer to that seems to be different at any one moment in time. Right at this moment, I'm ok. Yesterday at about three in the afternoon, sooo *not* ok that I was a teeny-tiny bit scared.

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I know. :sad:

I've decided what I think would ultimately be the *best* choice, but I concede that it is anywhere from hard to nearly impossible.

I'm trying it anyway.

Still, I've been very clear with myself that I'm gonna let myself off the hook without guilt if I just can't get through it, or if the thoughts that life just isn't worth it become more pervasive. Judging when I've reached a level that is dangerous is the hard part, and my answer to that seems to be different at any one moment in time. Right at this moment, I'm ok. Yesterday at about three in the afternoon, sooo *not* ok that I was a teeny-tiny bit scared.

 

The bolded is why I would encourage you to be totally honest with your therapist. You need someone who can give you an objective view about where you are in relation to harming yourself. If you cross the line, you might not have the mental wherewithal to realize it or to prevent a tragedy. Having a safeguard in this respect is just as important for your kids as the other things you are doing.

 

I am so sorry you are having to walk this hard road. I will be praying for you.

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Praying for you Julie. I wish that there was more I could do.

Please don't neglect to fit yourself for independence. You are going to feel better on every level when you can picture supporting yourself, even if you don't choose to do so independently right at that point. I know that's part of the plan, but make sure it doesn't fall off the plate.

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Also. And I waited a long time to post this, but finally decided that I had better do so.

That part about how your DH is not himself because the man you married could not possibly look at you hurting like this and not react?

(Deep breath)

This is classic "I'm not in love with you at all anymore" behavior. Specifically it is also often "And in fact I am in love with someone else" behavior.

Classic.

Please be very careful not to have this be one of the main things that leads you to the conclusion that he is not himself and that he needs your help.

And the part about how he doesn't remember this sounds far more like "I just don't want to talk about it" to me.

 

I'm sorry to say this and to be so blunt, but I think that it is the exact truth and needs to be considered.

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